Provider Demographics
NPI:1669818035
Name:RISE EARLY INTERVENTION SERVICES LLC
Entity Type:Organization
Organization Name:RISE EARLY INTERVENTION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCUSO
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:480-295-4958
Mailing Address - Street 1:4554 E INVERNESS AVE
Mailing Address - Street 2:STE C3
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4639
Mailing Address - Country:US
Mailing Address - Phone:480-295-4925
Mailing Address - Fax:480-497-4756
Practice Address - Street 1:4554 E INVERNESS AVE
Practice Address - Street 2:STE C3
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4639
Practice Address - Country:US
Practice Address - Phone:480-295-4925
Practice Address - Fax:480-497-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ949156Medicaid